If you’re experiencing discomfort and problems with your upper gastrointestinal (GI) tract, such as abdominal pain, heartburn that won’t go away, and bleeding, you know you may need an endoscopy. It’s an important procedure that your doctor may order to diagnose problems with your throat, esophagus, stomach, and the initial portion of the small intestine.
Now, you’re probably wondering how much endoscopy costs.
On average, an endoscopy costs $2,750 in the US without insurance. The price ranges between $1,400 and over $12,000, depending on several factors. These include the facility, location, and insurance, along with other additional costs.
What are the factors that affect the cost of endoscopy?
Several factors can affect the cost you’ll have to pay for the endoscopy procedure. You need to consider these factors to know if you can afford the procedure and how you can come financially prepared.
1. Type of Facility
The cost of endoscopy may vary based on the type of facility where you get the procedure.
- In-patient. It’s more costly to get an endoscopy at an in-patient facility, such as a hospital, because of the hospital charges and other miscellaneous expenses. It can cost an average of $4,350.
- Outpatient. Outpatient facilities, such as clinics and surgical centers, charge an average of $2,550 for endoscopy procedures, which is cheaper than in-patient facilities.
Another factor that affects the cost of endoscopy is the location where you get the endoscopy.
Here are the price ranges in some cities in the US.
|Atlanta, GA||$1,400 to $10,000|
|Chicago, IL||$2,600 to $8,000|
|Dallas, TX||$2,500 to $9,000|
|Houston,TX||$2,500 to $10,200|
|Philadelphia, PA||$1,900 to $12,600|
|New York, NY||$2,400 to $12,000|
|Phoenix, AZ||$1,600 to $10,500|
3. Insurance Status
Your insurance status may also affect the cost of endoscopy.
With insurance, you can expect to pay less out-of-pocket for the endoscopy procedure.
However, you still have shared responsibility because you have to pay deductibles, office visit copay, and coinsurance amounts, depending on the health plan you bought.
In some cases, you may need to pay around $1,000 only in deductibles and copays, or 10%-50% coinsurance of the total amount of the procedure.
Without insurance, you’ll pay the entire cost of the procedure, including doctor fees, prescriptions, and lab fees.
While the national average cost of endoscopy is $2,750, it can go over $10,000 for an upper GI endoscopy procedure if you’re not insured.
4. Additional Costs
There are additional costs that can affect the final price of your endoscopy procedure. These include the following:
- Prescription – You may need to take medicines for the procedure, such as painkillers or sedatives. Make sure that the prescriptions are covered by your insurance. If you’re uninsured, you may ask your doctor if there is a generic version of the prescribed medicine so you can lower the cost.
- Check-ups – Before the procedure, you’ll have to pay for the cost of checkups or doctor consultations. You may need to return for a follow-up visit, which may be charged separately.
- Biopsy – Your doctor may order a biopsy to help in the diagnosis. The cost of biopsy alone ranges from $1,100 to $4,800, which will add to your final bill.
- Sedatives and Anesthesia – You may be charged extra for the anesthesia and sedatives, which may cost around $500 to $600.
How Can You Reduce the Price of Endoscopy?
You can lessen the cost of the endoscopy procedure by taking extra steps. Here are some tips:
1. Seek Payment Assistance
You can look for patient health payment assistance programs, which can help you pay for the endoscopy procedure. One example is the Patient Assist Program which provides discounts and special payment financing options to patients.
Designed by a group of doctors and facilities, this program includes an Endoscopy Assistance Program to help patients who need to undergo an endoscopy procedure. Qualified patients can get the procedure at a reasonable price even without insurance.
Before you proceed to an endoscopy procedure, you need to meet a physician for consultation. A care coordinator will be assigned to you to determine the deposit you need to make, which is usually around $200-$350.
New Choice Health company, the parent company behind the Patient Assist Program will only be billed for your procedure. You can pay your invoice via Credit Card, ACH/Bank transfer, Check or Money Order, via Financing programs through your Health Savings Account seven days prior to your appointment.
If you’re qualified, you’ll only have to pay an average of $1,000, covering physician fees, facility fees, anesthesia fees, and pathology or lab fees.
2. Use your Medicare
You can save on the cost of endoscopy if you have Medicare insurance. Depending on the Medicare Advantage plan you signed up for, it can cover up to 80% of the cost of your procedure after you pay your annual $203 deductible.
Medicare coverage also depends on where the procedure took place. If you get the endoscopy at an in-patient facility during confinement, the procedure is covered under Medicare Part A. It means that you’re not required to pay a monthly premium but you have to pay your deductibles.
If you undergo an endoscopy at an outpatient facility, Medicare Part B covers the cost. Although, you have to pay a monthly premium, deductibles, and 20% of the total cost approved by Medicare.
3. Visit a Low-Cost Clinic
You can consider going to the low-cost clinics, such as NYC Free clinic and the Clinic at Brackenridge in Austin, TX, that offer access to specialist care.
You can also visit the US Department of Health & Human Services to find a federally funded health clinic near you.
4. Get the Procedure from an Outpatient Facility
As much as possible, get your procedure at an outpatient facility. In-patient facilities tend to charge higher because they’re more expensive to maintain.
5. Go to the Nearby Low-Cost Location
If you live in a city where endoscopy costs are high, consider visiting a nearby city where you can get the procedure for a lower price.
Based on our list above, you may want to consider Atlanta and Chicago.
6. Use an In-Network Provider
If you have insurance, get your endoscopy procedure from one of the in-network providers. They have cheaper prices because the rates are contracted by your health insurance company.
Endoscopy is an important procedure that helps diagnose some digestive disorders. The procedure can be pricey, depending on a number of factors. Some factors that affect the cost of endoscopy procedures include the facility, location, and insurance status.
If you have insurance, it can cover the cost of your procedure after you pay your deductibles. Without insurance, you’ll be responsible for the total cost.
However, you can also reduce the cost of the endoscopy procedure by taking extra steps: seek payment assistance, use your Medicare, visit a low-cost clinic, get an outpatient procedure, go to a nearby low-cost location, and use an in-network provider if you have insurance.